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Colón LF, Barber L, Soffin E, Albert TJ, Katsuura Y. Airway Complications After Anterior Cervical Spine Surgery: Etiology and Risk Factors. Global Spine J 2023; 13:2526-2540. [PMID: 36892830 PMCID: PMC10538311 DOI: 10.1177/21925682231160072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVE To provide an overview of etiology and risk factors of airway complications after anterior cervical spine surgery (ACSS). METHODS A search was performed in PubMed and adapted for use in other databases, including Embase, Cochrane Library, Cochrane Register of Controlled Trials, Health Technology Assessment database, and NHS Economic Evaluation Database. RESULTS 81 full-text studies were reviewed. A total of 53 papers were included were included in the review and an additional four references were extracted from other references. 39 papers were categorized as etiology and 42 as risk factors. CONCLUSIONS Most of the literature on airway compromise after ACSS is level III or IV evidence. Currently, there are no systems in place to risk-stratify patients undergoing ACSS regarding airway compromise or guidelines on how to manage patients when these complications do occur. This review focused on theory, primarily etiology and risk factors.
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Affiliation(s)
- Luis Felipe Colón
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine in Chattanooga, Chattanooga, TN, USA
| | - Lauren Barber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ellen Soffin
- Department of Anesthesiology, Critical Care, and Pain Management; Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yoshihiro Katsuura
- Department of Orthopaedic and Spine Surgery, Adventist Health Howard Memorial Hospital, Willits, CA, USA
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Dodo Y, Okano I, Zelenty WD, Paek S, Sarin M, Haffer H, Muellner M, Chiapparelli E, Shue J, Soffin E, Lebl DR, Cammisa FP, Girardi FP, Sokunbi G, Sama AA, Hughes AP. The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State. Spine (Phila Pa 1976) 2023:00007632-990000000-00316. [PMID: 37040475 DOI: 10.1097/brs.0000000000004603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
STUDY DESIGN Retrospective database analysis. OBJECTIVE To elucidate trends in the utilization of IONM during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes. SUMMARY OF BACKGROUND DATA The routine use of Intraoperative Neurophysiological Monitoring (IONM) in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost and other substitute advanced technologies. METHODS The Statewide Planning and Research Cooperative System (SPARCS) database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses as well as propensity score matching (PS-matching) were conducted to assess IONM association in neurological deficits reduction. RESULTS The utilization of IONM showed an increase in a linear fashion from 79 cases in 2007 to 6,201 cases in 2018. A total of 34,592 (12,419 monitored and 22,173 unmonitored) patients were extracted, and 210 patients (0.6%) were reported for postoperative neurological deficits. Unadjusted comparisons demonstrated that the IONM group was associated with significantly fewer neurological complications. However, multivariable analysis indicated that IONM was not a significant predictor of neurological injuries. After PS-matching of 23,642 patients, the incidence of neurological deficits was not significantly different between IONM and non-IONM patients. CONCLUSION The utilization of IONM for elective lumbar surgeries continues to gain popularity. Our results indicated that IONM use was not associated with a reduction in neurological deficits and will not support routine use of IONM for all elective lumbar surgery.
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Affiliation(s)
- Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - William D Zelenty
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel Paek
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Michele Sarin
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | | | | | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Ellen Soffin
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Darren R Lebl
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Gbolabo Sokunbi
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York, NY, USA
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Zelenty WD, Paek S, Dodo Y, Sarin M, Shue J, Soffin E, Lebl DR, Cammisa FP, Girardi FP, Sokunbi G, Sama AA, Hughes AP. Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State. Spine (Phila Pa 1976) 2023; 48:492-500. [PMID: 36576864 DOI: 10.1097/brs.0000000000004569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To elucidate trends in the utilization of intraoperative neuromonitoring (IONM) during anterior cervical discectomy and fusion (ACDF) procedures in NY state using the Statewide Planning and Research Cooperative System and to determine if utilization of IONM resulted in a reduction in postoperative neurological deficits. SUMMARY OF BACKGROUND DATA IONM has been available to spinal surgeons for several decades. It has become increasingly prevalent in all facets of spinal surgery including elective ACDF procedures. The utility of IONM for preventing a neurological deficit in elective spine procedures has recently been called into question. MATERIALS AND METHODS The Statewide Planning and Research Cooperative System database were accessed to perform a retrospective cohort study comparing monitored versus unmonitored ACDF procedures between 2007 and 2018 as defined by the International Classification of Disease-9 and 10 Procedural Coding System (ICD-9 PCS, ICD-10 PCS) codes. Patient demographics, medical history, surgical intervention, pertinent in-hospital events, and urban versus rural medical centers (as defined by the United States Office of Management and Budget) were recorded. Propensity-score-matched comparisons were used to identify factors related to the utilization of IONM and risk factors for neurological deficits after elective ACDF. RESULTS A total of 70,838 [15,092 monitored (21.3%) and 55,746 (78.7%) unmonitored] patients' data were extracted. The utilization of IONM since 2007 has increased in a linear manner from 0.9% of cases in 2007 to 36.7% by 2018. Overall, baseline characteristics of patients who were monitored during cases differed significantly from unmonitored patients in age, race/ethnicity, insurance type, presence of myelopathy or radiculopathy, and Charlson Comorbidity Index; however, only race/ethnicity was statistically significant when analyzed using propensity-score-matched. When comparing urban and rural medical centers, there is a significant lag in the adoption of the technology with no monitored cases in rural centers until 2012 with significant fluctuations in utilization compared with steadily increasing utilization among urban centers. From 2017 to 2018, reporting of neurological deficits after surgery resembled literature-established norms. Pooled analysis of these years revealed that the incidence of neurological complications occurred more frequently in monitored cases than in unmonitored (3.0% vs. 1.4%, P < 0.001). CONCLUSIONS The utility of IONM for elective ACDF remains uncertain; however, it continues to gain popularity for routine cases. For medical centers that lack similar resources to centers in more densely populated regions of NY state, reliable access to this technology is not a certainty. In our analysis of intraoperative neurological complications, it seems that IONM is not protective against neurological injury.
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Affiliation(s)
- William D Zelenty
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Samuel Paek
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Yusuke Dodo
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
- Department of Orthopedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Michele Sarin
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Jennifer Shue
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Ellen Soffin
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Darren R Lebl
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Frank P Cammisa
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Federico P Girardi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Gbolabo Sokunbi
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Andrew A Sama
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
| | - Alexander P Hughes
- Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, NY
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Lovecchio F, Steinhaus M, Elysee JC, Huang A, Ang B, Lafage R, Yang J, Soffin E, Craig C, Lafage V, Schwab F, Kim HJ. Factors Associated With Short Length of Stay After Long Fusions for Adult Spinal Deformity: Initial Steps Toward Developing an Enhanced Recovery Pathway. Global Spine J 2021; 11:866-873. [PMID: 32787569 PMCID: PMC8258808 DOI: 10.1177/2192568220941448] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The identification of case types and institutional factors associated with reduced length of stay (LOS) is a key initial step to inform the creation of clinical care pathways that can assist hospitals to maximize the benefit of value-based payment models. The objective of this study was to identify preoperative, intraoperative, and postoperative factors associated with shorter than expected LOS after adult spinal deformity (ASD) surgery. METHODS A retrospective cohort study was performed of 82 patients with ASD who underwent ≥5 levels of fusion to the pelvis between 2013 and 2018. A LOS <6 days was determined as a basis for comparison, as 5.7 days was the "expected LOS" generated through Poisson regression modeling of the sample. Clinical, radiographic, surgical, and postoperative factors were compared between those staying ≥6 days (L group) and <6 days (S group). Logistic regression was used to identify factors associated with LOS <6 days. RESULTS A total of 35 patients were in group S (42.7%). Gender, age, body mass index, ASA (American Society of Anesthesiologists) class, and use of preoperative narcotics, revision surgery, day of admission, and surgical complications did not vary between the cohorts (P > .05). Mild-moderate preoperative sagittal deformity (sagittal Schwab modifiers 0 or +), lower estimated blood loss (<1200 mL), fewer levels fused (7 vs 10 levels), shorter operating room time, procedure end time before 15:00, and no intensive care unit stay, were associated with short LOS (P < .05). Only 1 major medical complication occurred in the short LOS group (P < .05). CONCLUSIONS This study identifies the ASD "case phenotype," intra-, and postoperative benchmarks associated with shorter LOS, providing targets for pathways designed to reduce LOS.
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Affiliation(s)
| | | | | | - Alex Huang
- Hospital for Special Surgery, New York, NY, USA
| | - Bryan Ang
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Chad Craig
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA,Han Jo Kim, MD, Hospital for Special Surgery, 541 East 71st Street, New York, NY 10021, USA.
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Watson J, Roberts C, Scott C, Kendall I, Collin L, Day NC, Harries MH, Soffin E, Davies CH, Randall AD, Heightman T, Gaster L, Wyman P, Parker C, Price GW, Middlemiss DN. SB-272183, a selective 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptor antagonist in native tissue. Br J Pharmacol 2001; 133:797-806. [PMID: 11454652 PMCID: PMC1572841 DOI: 10.1038/sj.bjp.0704133] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2001] [Revised: 04/27/2001] [Accepted: 04/27/2001] [Indexed: 11/08/2022] Open
Abstract
A novel compound, SB-272183 (5-Chloro-2, 3-dihydro-6-[4-methylpiperazin-1-yl]-1[4-pyridin-4-yl]napth-1-ylaminocarbonyl]-1H-indole), has been shown to have high affinity for human 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptors with pK(i) values of 8.0, 8.1 and 8.7 respectively and is at least 30 fold selective over a range of other receptors. [(35)S]-GTPgammaS binding studies showed that SB-272183 acts as a partial agonist at human recombinant 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptors with intrinsic activities of 0.4, 0.4 and 0.8 respectively, compared to 5-HT. SB-272183 inhibited 5-HT-induced stimulation of [(35)S]-GTPgammaS binding at human 5-HT(1A) and 5-HT(1B) receptors to give pA(2) values of 8.2 and 8.5 respectively. However, from [(35)S]-GTPgammaS autoradiographic studies in rat and human dorsal raphe nucleus, SB-272183 did not display intrinsic activity up to 10 microM but did block 5-HT-induced stimulation of [(35)S]-GTPgammaS binding. From electrophysiological studies in rat raphe slices in vitro, SB-272183 did not effect cell firing rate up to 1 microM but was able to attenuate (+)8-OH-DPAT-induced inhibition of cell firing to give an apparent pK(b) of 7.1. SB-272183 potentiated electrically-stimulated [(3)H]-5-HT release from rat and guinea-pig cortical slices at 100 and 1000 nM, similar to results previously obtained with the 5-HT(1B) and 5-HT(1D) receptor antagonist, GR127935. Fast cyclic voltammetry studies in rat dorsal raphe nucleus showed that SB-272183 could block sumatriptan-induced inhibition of 5-HT efflux, with an apparent pK(b) of 7.2, but did not effect basal efflux up to 1 microM. These studies show that, in vitro, SB-272183 acts as an antagonist at native tissue 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptors.
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MESH Headings
- 8-Hydroxy-2-(di-n-propylamino)tetralin/pharmacology
- Action Potentials/drug effects
- Aged
- Aged, 80 and over
- Animals
- Autoradiography
- Binding, Competitive/drug effects
- Cerebral Cortex/drug effects
- Cerebral Cortex/metabolism
- Dose-Response Relationship, Drug
- Electric Stimulation
- Female
- Guanosine 5'-O-(3-Thiotriphosphate)/metabolism
- Guinea Pigs
- Humans
- Indoles/metabolism
- Indoles/pharmacology
- Mesencephalon/drug effects
- Mesencephalon/metabolism
- Middle Aged
- Neurons/drug effects
- Neurons/physiology
- Piperazines/metabolism
- Piperazines/pharmacology
- Pyridines/pharmacology
- Radioligand Assay
- Raphe Nuclei/cytology
- Raphe Nuclei/drug effects
- Raphe Nuclei/metabolism
- Rats
- Receptor, Serotonin, 5-HT1B
- Receptor, Serotonin, 5-HT1D
- Receptors, Serotonin/drug effects
- Receptors, Serotonin/metabolism
- Receptors, Serotonin, 5-HT1
- Serotonin/metabolism
- Serotonin/pharmacology
- Serotonin Antagonists/metabolism
- Serotonin Antagonists/pharmacology
- Serotonin Receptor Agonists/pharmacology
- Sulfur Radioisotopes
- Tritium
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Affiliation(s)
- J Watson
- Neuroscience Research and Department of Medicinal Chemistry, GlaxoSmithKline, New Frontiers Science Park, Third Avenue, Harlow, Essex, CM19 5AW.
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